Abstract
Overweight and obesity have become increasingly common; worldwide, at least 1.1 billion adults are overweight and 312 million are obese, when overweight and obesity are defined conventionally as having a body mass index (BMI) of >25 kg/m2 and >30 kg/m2, respectively.1,2 In the general population, overweight and obesity are associated with increased risk of developing cardiovascular disease,3,4 and thus it is not surprising that in cohorts of patients with prevalent ischemic heart disease or acute coronary events, well over 50% are overweight or obese.5,6 Despite the association between obesity and cardiovascular risk in the general population, a multitude of studies have described an inverse correlation between BMI and mortality in patients with coronary artery disease (CAD), including post-coronary revascularization patients and those with acute myocardial infarction (MI); the association between elevated BMI and improved survival has been termed the obesity paradox .7,8 Article p 482 In this issue of Circulation , Zeller et al9 further investigate the obesity paradox in a cohort of 2229 consecutive patients presenting with acute MI in the Cote d’Or region of France. In assessing the impact of obesity on mortality after MI, the group uses both BMI, a traditional index of obesity, as well as waist circumference, an alternate anthropometric index that is more specific for abdominal obesity. Approximately one-half of the subjects in the study were overweight (BMI 25 to 29.9 kg/m2), one-quarter were obese (BMI >30 kg/m2) and one-half had increased waist circumference, which was defined as >102 cm in men and >88 cm in women. Left ventricular ejection fraction, type of MI, and acute treatment strategy did not generally differ by BMI or waist circumference values. Of note, BMI was inversely correlated with age and plasma N-terminal pro B-type natriuretic peptide, whereas …
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